ATI RN
Assessing Vital Signs Questions
Question 1 of 5
During an examination of a child, the nurse considers that physical growth is the best index of a child's:
Correct Answer: A
Rationale: The correct answer is A: General health. Physical growth is a reflection of overall health status in children. Adequate growth indicates proper nutrition, absence of chronic illness, and normal development. Monitoring growth parameters like height and weight can provide valuable insights into a child's well-being. The other choices are incorrect because while genetics (B) can influence growth potential, it doesn't directly indicate the current health status. Nutritional status (C) is important for growth but doesn't encompass all aspects of health. Activity and exercise patterns (D) are important for overall health but don't solely determine a child's general health status.
Question 2 of 5
Which of these specific measurements is the best index of a child's general health?
Correct Answer: B
Rationale: The correct answer is B: Height and weight. These measurements provide important indicators of a child's growth and development, which are key components of overall health. Height and weight measurements can help assess nutritional status, growth patterns, and potential health issues. Vital signs (A) are important for monitoring immediate health status but do not provide a comprehensive view of general health. Head circumference (C) is primarily used in infancy to assess brain development. Chest circumference (D) is not typically used as a general health indicator in children. In summary, height and weight measurements offer a holistic view of a child's health by evaluating growth, nutrition, and overall well-being.
Question 3 of 5
A patient comes to the clinic and states that he has noticed that his skin is redder than normal. The nurse understands that this condition is due to hyperemia and knows that it can be caused by:
Correct Answer: D
Rationale: The correct answer is D: Excess blood in the dilated superficial capillaries. Hyperemia is characterized by an increase in blood flow to a specific area, leading to redness. This is caused by vasodilation of superficial capillaries, allowing more blood to flow through the area. Choices A and C are incorrect because decreased amounts of bilirubin in the blood and decreased perfusion do not lead to hyperemia. Choice B is incorrect because excess blood in the underlying blood vessels does not directly cause the redness seen in hyperemia.
Question 4 of 5
The nurse is assessing a patient who has liver disease for jaundice. Which of these assessment findings is indicative of true jaundice?
Correct Answer: B
Rationale: The correct answer is B because the yellow color of the sclera extending up to the iris is indicative of true jaundice, known as scleral icterus. This occurs when there is an excess of bilirubin in the blood, causing yellow discoloration. Yellow patches in the outer sclera (choice A) may be due to other causes like pinguecula. Skin appearing yellow under low light (choice C) may be due to lighting conditions. Yellow deposits on palms and soles (choice D) are seen in conditions like carotenemia, not jaundice.
Question 5 of 5
The nurse is taking the history of a patient who may have a perforated eardrum. What would be an important question in this situation?
Correct Answer: D
Rationale: Rationale for Correct Answer (D): Asking about the relationship between ear pain and discharge is crucial in assessing for a perforated eardrum. Pain and discharge are common symptoms, indicating a possible perforation. This question helps to determine the presence and severity of these symptoms, aiding in diagnosis and treatment planning. Summary of Incorrect Choices: A: Asking about ringing or crackling in the ears is not specific to a perforated eardrum. B: Inquiring about the last hearing check does not directly address symptoms related to a perforated eardrum. C: Asking about previous hearing loss is not directly relevant to assessing for a perforated eardrum.